There are no cartoon characters adorning the walls in the HKS-designed Phoenix Children’s Hospital expansion (left). Rather, the sophisticated interior utilizes images from nature—in this case, desert flowers—and softer colors. The firm’s design for the Royal Children’s Hospital in Melbourne, Australia (right), addresses children’s love of discovery by including a two-story coral reef aquarium—with sharks!—in the entry lobby. Rendering: HKS
Think children's hospital design, and what images spring to mind? Way too many bright, bold colors? An explosion of cartoon characters—on the walls, floors, and furniture? A nauseatingly cute and cuddly décor?
"I feel sorry for people in some of the children's facilities I visit because every day they're confronted with iffy colors and cartoon characters everywhere," says Ronald W. Dennis, AIA, principal and the director of children's health facility design at HKS, Dallas. With children's hospitals treating patients ranging from newborns to 18-year-olds, "The design needs to appeal to patients of all ages," says Dennis.
|Consider these nine design concepts:
1. Ramp up the level of sophistication.
2. Create multi-zoned patient rooms.
3. Make overnight accommodations a must.
4. Pump up in-room storage.
5. Plug in parental work space.
6. Carve out family respite spaces.
7. Isolate entertainment systems for privacy.
8. Control your lighting.
9. Get wayfinding right.
And don't forget the parents. "There are always more adults in a children's hospital than there are children," says Joe Kuspan, AIA, director of design at Karlsberger, Columbus, Ohio. They're just as stressed as their children. Adds Ana Pinto-Alexander, president of Maregatti Interiors, Indianapolis, "Going to the hospital is just as traumatic an experience for parents as it is for children. The environment has to soothe the parent who is suffering too."
With these concerns in mind, children's hospital design is trending toward more sophisticated, family-friendly environments that address patient and parent needs without alienating the staff. The following nine ideas illustrate what's expected in today's best children's hospitals.
"The facility cannot be cute." That was the directive given Pinto-Alexander by administrators at Riley Hospital in Indianapolis. They wanted their new 650,000-sf, 10-story Simon Family Tower (an Earl Swensson Associates project) to have an elegant interior design. At the same time, the hospital directors wanted all who entered its precincts to be well aware that Riley was a children's hospital.
Pinto-Alexander's strategy for meeting these potentially conflicting mandates: be playful but sophisticated, by focusing on layered design, a toned-down color palette, and universal themes and imagery.
In the case of Riley Hospital, layering involved creating a three-dimensional interior environment through the use of varying elements and materials. "Children love to touch, and they love a reveal," so interiors needed to be textural and engaging, says Pinto-Alexander. Layered interior designs also allow children to discover something new every time they visit. Remember, many patients at children's hospitals are repeat visitors.
|Karlsberger designed the light-filled entrance atrium in the 181-bed, 231,000-sf Levine Children’s Hospital in Charlotte, N.C., to accommodate multiple seating areas that also serve as family respite space. Photo: Feinknopf Photography|
Another strategy for layering design that's advocated by Brenda Smith, RID, IIDA, LEED AP, is to integrate interactive elements. The former nurse and now healthcare interiors team lead with Perkins+Will, Atlanta, says that an interactive wall—using light displays or features that react to a child's touch, for example—can be used to entertain and educate. It can also provide an element of discovery and reveal that is appealing to children. She cautions, however, that "you need to build something that's easily maintained because the moment it goes down, you've got a blank wall."
While interactive elements can be as wild as your imagination—and budget—allow, David Quenemoen, AIA, LEED AP, adds a word of caution about creating elements that are too wild and become what lawyers call "attractive nuisances."
"Use playful items throughout the building, but make sure there's nothing that can be climbed on," says Quenemoen, a VP at PageSoutherlandPage in Houston and lead designer of Texas Children's West Campus. "What's unique to a children's hospital is that you have children running around the facility, including siblings, so always ask yourself what's the worst thing a little kid can do here, and design for that."
"The climb-on issue is just the tip of the iceberg," says Pamela Ward O'Malley, a project executive with Gilbane Building Companies. "Good pediatric design needs to consider patient safety first, material softness, durability, sharp edges, and indestructible construction, which is important in all patient areas, from waiting to treatment to inpatient," she says.
Color is still very important to children's hospitals, but Perkins+Will's Smith says primary colors are out. It's important to appeal to all ages through the use of softer colors and a natural palette. Be sure to use a variety of colors, however, because single-color schemes get tiresome. However, the color palette for children's cancer facilities should not include red, says Philip Tobey, FAIA, FACHA, SVP of healthcare with SmithGroup, Washington, D.C. It reminds children of their chemo drugs, he says.
The rallying cry among hospital designers is that cartoon characters should be banned. In their place, use images of nature—flowers, trees, mountains, water, beaches, for example—that hospital users of all ages and backgrounds can identify with.
Three things to avoid: 1) anything too age-specific, keeping in mind that patients' ages run the gamut; 2) anything too "local," such as logos or decorations for local sports teams, as these can alienate patients (and bill-paying parents) from out of town or those who care little about sports; and 3) abstract images. Cautions Karlsberger's Joe Kuspan. "Any image or design that's too abstract becomes meaningless to [most] people."
Maregatti Interiors' Pinto-Alexander is one of a growing number of healthcare designers who advocate zoned inpatient rooms. The all-private patient rooms she designed for the Simon Family Tower are divided into three zones to accommodate staff, patient, and family.
For efficiency and privacy, it's best to locate the staff zone at the front of the room and the family zone at the rear, so visitors and their belongings can be kept out of the way. Curtains can be used to close off the spaces for added privacy.
The patient zone at the center of the room should be flexible. In the Simon Family Tower, these zones can handle children from infants to teens by simply switching out the beds.
Important: Make sure patient bathrooms are equally flexible: Is the showerhead tall enough for a teenager? Is the toilet low enough for a child to use comfortably?
It's also important to plan on extra space for children's hospitals. Adult facilities average 700–800 DGSF (departmental gross square feet) per bed, whereas children's facilities average 1,000 DGSF, says Gilbane's Ward O'Malley.
While the three-zone layout is widely accepted, there is still debate over mirror-reverse or same-hand set-up for headwalls. Without conclusive evidence one way or the other, most hospital clients will ask for mirror-reverse rooms to take advantage of efficiencies, such as shared plumbing chases and headwall lines, and the ability to locate a nursing substation between two rooms; same-hand rooms cannot share a substation.
Patient rooms must have comfortable and abundant seating that doubles as sleeping space, since at least one parent often beds down in the child's room. Some hospitals are now requesting sleeping space sufficient for two adults. At Simon Family Tower, Pinto-Alexander asked parents and visitors to test furniture samples in the hospital lobby and then installed the most popular units in patient rooms. The "winning" sofa doubles as a twin-size sleeper, while the recliner provides a second sleeping option.
Overnight accommodations for at least one parent in the patient room are a must. The oversized sofa in the family zone in patient rooms at Levine Children’s Hospital doubles as a twin bed. Photo: Feinknopf Photography
Karlsberger's Joe Kuspan suggests using a trundle bed instead of a traditional sleeping sofa. His reasoning: The trundle bed is a no-muss, no-fuss solution that can be closed in the morning with all bedding still on it and pulled out again at night without have to be remade. He's discovered that trundle beds are also popular with staff. "Nurses don't want to be the police and tell people to make their beds and put all their stuff away," he says. "They like how easily trundle beds solve that problem."
Gilbane's Ward O'Malley agrees. "Be wary of sleeping solutions with movable parts or anything that flips up and down," she says. "Pinching fingers are a risk. Trundle beds limit that possibility."
Family-friendly facilities need extra storage to accommodate everything parents bring for themselves, the patient, and the siblings they drag along. Plan for enough storage to accommodate a four-day stay, recommends Gilbane's Ward O'Malley. Kurt Neubek, FAIA, LEED AP, associate principal and director of healthcare for PageSoutherlandPage, Houston, incorporated a floor-to-ceiling alcove (roughly 60 cubic feet) in inpatient rooms at the new 345,000-sf, 96-bed Texas Children's West Campus in Houston so parents have a dedicated space to stash bulky items like luggage and strollers.
But beware! Hospital staff may not welcome extra closets and cabinets. "Sometimes there's resistance [from staff] because families don't always take everything with them, and the more storage space there is, the more hospitals have to worry about cleaning up," says Perkins+Will's Smith.
A. Patient rooms in the Simon Family Tower at Riley Hospital are zoned to accommodate staff, patient, and family. B. All-patient activity center. C. Teen activity center. D. Family laundry room. E. Family respite room with seating, kitchenette, and work space. F. Children’s activity center. Floor Plan: Maregatti Interiors
Parents and adult visitors often need to continue working while at the hospital with their children, so each patient room should have a desk within the family zone. Be sure to provide Internet access—parents are creating websites to update family and friends on their child's progress, says Ward O'Malley. Include multiple outlets for laptops, cell phones, iPods, and other electronics. Work surfaces typically double as overflow seating, so Pinto-Alexander specifies that tables be hung on heavy-duty brackets to accommodate the weight.
Additional parental workspace should be considered outside the patient room, recommends 2006 "40 under 40" winner Natalie Petzoldt, AIA, LEED AP, VP with Cannon Design in St. Louis. Her advice: include a "mini" business center—for private calls, faxing, printing, photocopying—on each patient floor rather than creating one central business center that serves the entire hospital.
Each nursing unit should include a family room or space that parents and other family members can utilize when they need time outside of but still near the patient's room.
SmithGroup's Tobey advocates designing a family room directly adjacent to a patient room rather than incorporating a shared family support space. The firm's St. Jude's Children's Research Hospital project in Memphis, Tenn., included a private family room for each of the three 18-bed nursing units.
Parents caring for sick children often have to continue working, so children’s hospitals should include dedicated work space both inside and outside patient rooms. Levine Children’s Hospital includes a zoned library, which parents can treat as a mini business center, complete with computer carrels. Photo: Feinknopf Photography
Shared family rooms should be zoned with a comfortably appointed living room, a children's area for young siblings, a work/research area, and a kitchenette with eating table and a refrigerator. Ward O'Malley says facilities should have two refrigerators, one for patient food and one for breast milk. The appliances are best left in a central location rather than installed in patient rooms. "Maintaining all of these appliances in accordance with the JCAHO demand for temperature monitoring means that in-room refrigeration can be an operational nightmare," she says.
Some facilities have a comprehensive kitchen, but with hospitals offering more on-demand food options, some administrators look at a kitchen as one more thing to clean and maintain. Laundry facilities are also sometimes included, but usually only in facilities where patients require longer stays.
Look to the lobby or entrance atrium for room to create such respite areas. "In this day and age, you have to use the atrium spaces or they get cut out of the budget," says Jeffrey Stouffer AIA, principal at HKS, in Dallas. "Justify having them by putting them to good use as family space." The atrium in Stouffer's current project, the new $588 million, 246-bed Phoenix Children's Hospital expansion, also serves as the main street, with registration, pharmacy, gift shop, and dining room connected to the space.
The family room in the Simon Family Tower at Riley Hospital is designed with both adults and children in mind. The zoned space has a sitting area for reading or watching TV, a kitchenette, and a quiet work area. Rendering: Maregatti Interiors
These respite areas don't always have to be quiet, serene spaces, says Tobey, an editorial advisor to BD+C. Exercise is a great stress reliever, so he suggests creating a work-out room for parents, with lots of natural daylight.
Respite spaces need not be limited to the indoors. Hospitals should include outdoor spaces for use by both family members and patients; consider a rooftop garden for facilities on tight urban sites. Outdoors spaces also give patients views of nature, which has been shown to have a positive effect on the healing process. Important: Make sure plants and flowers used in the landscaping are large enough to be viewed from a distance so patients can see them from their rooms, says Pinto-Alexander.
Respite spaces need not be limited to the indoors; outdoor spaces, like this one at Royal Children’s Hospital, which is located in a Melbourne city park, can be used by both patients and family. The extensive landscaping can also be seen from patient rooms; views of nature can help the healing process. Rendering: HKS
Patient rooms in the Simon Family Tower at Riley Hospital in Indianapolis have zoned entertainment: one large, wall-mounted flat-screen TV on the wall across from the patient bed with another in the family zone. Speakers are situated such that the televisions can only be heard in their respective zones. Rooms also have DVD players, and some even have gaming systems, such as a Wii.
Play zones outside the patient room, typically on the nursing unit, allow patients, visiting siblings, and their friends to socialize and get some relief from the hospital routine. Ideally, children's hospitals should separate playrooms or entertainment spaces for children from those for teenagers. "Teens are tough," says former nurse Brenda Smith. "If there's anything that screams 'kid,' they don't want any part of it."
When it comes to lighting patient rooms, each of three zones—staff, patient, and family—should have its own lighting controls so that illumination can be adjusted without disturbing occupants of the other zones. HKS's Stouffer also recommends programming lights to dim at night in the corridors and in non-work spaces to quiet people down and create a calm, soothing environment.
9. Get the wayfinding right.
Going to the hospital is a sufficiently disorienting experience for children and parents without the added stress of poor wayfinding. Pinto-Alexander says that it's important to work wayfinding into the design, rather than relying solely on signage. "Wayfinding has to be intuitive so children, who may not be able to read yet, and who often lead parents around, can recognize a tree or flower and follow those images through the facility," she says. The use of graphic guides is also helpful to patients and parents who don't speak English.
Finally, here's a question to ask yourself: Do any of these concepts apply to other building types you're working on? If you think about it, there are probably several you could use in your next project, whether or not it's a children's hospital.